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Create Orders Infectious Disease Create Orders Antigen

Patient ID		First Name	Last Name	Date of Birth		Email	Date of Creation	Action

Create New Orders

Physician Name *

Lab Name *

Specimen Source *

ICD Code *

Date of Collection: *

Received Date: *

Email as N/A

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Create New Orders

Physician Name *

Lab Name *

Specimen Source *

ICD Code *

Date of Collection: *

Received Date:

Email as N/A

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Create New Orders

Physician Name *

Lab Name *

Specimen Source *

ICD Code *

Date of Collection: *

Received Date:

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Specimen ID and Photo

Physician Name

Enter Specimen ID

Specimen Photo

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